Original article: general thoracic
Video-assisted thoracic surgery for pure ground-glass opacities 2 cm or less in diameter

https://doi.org/10.1016/j.athoracsur.2003.12.040Get rights and content

Abstract

Background

Small, well-circumscribed pure ground-glass opacities on high-resolution computed tomography can represent either localized bronchioloalveolar carcinoma without foci of active fibroblastic proliferation, or atypical adenomatous hyperplasia. Since neither lesion displays lymph node metastasis, excellent prognosis can be expected even with limited surgical resection. In this study, video-assisted thoracic surgery was performed for patients with pure ground-glass-opacity to evaluate efficacy for both diagnostic and therapeutic purposes.

Methods

Thirty-nine patients with pure ground-glass opacity less than or equal to 2 cm in diameter (62 lesions) underwent video-assisted thoracic surgery with wedge resection as primary therapy. Histologic diagnoses were made according to Noguchi classifications.

Results

Single lesions were observed in 30 patients, with multiple lesions (mean, 4 lesions) in 9 patients. Twenty-eight patients underwent wedge resection. Seven patients underwent lobectomy or segmentectomy for technical reasons. Four patients underwent conversion of wedge resection to lobectomy (due to active fibroblastic proliferation in 2 patients, and other reasons in 2 patients). All procedures were performed under videoscopic observation. Histologic diagnoses comprised localized bronchioloalveolar carcinoma without active fibroblastic proliferation either alone or in combination with atypical adenomatous hyperplasia in 29 patients, atypical adenomatous hyperplasia in 8 patients, and localized bronchioloalveolar carcinoma with active fibroblastic proliferation in 2 patients. All patients with localized bronchioloalveolar carcinoma underwent follow-up for a median period of 29.3 months, and have survived without sign of recurrence.

Conclusions

Video-assisted thoracic surgery may be appropriate for management of small pure ground-glass opacities.

Section snippets

Patients and methods

Between January 2000 and February 2002, VATS was performed for 39 patients with 62 well-circumscribed nodules less than or equal to 2 cm in diameter, with greater than or equal to 98% GGO content on HRCT. To exclude findings of GGO attributable to inflammation, follow-up of GGO was undertaken for at least three months, and VATS resection was planned if lesion size or density increased or remained unchanged. Patients displaying GGO in combination with nodular-type lung cancer were excluded from

Results

Single lesions were identified in 30 patients, with multiple lesions (mean, 4 lesions; range, 2 to 7 lesions) in nine. One patient with multiple lesions displayed bilateral disease. Patient characteristics are listed in Table 1. All patients were asymptomatic, with GGO detected on helical CT during screening for lung cancer, or on CT investigation of other conditions. Preoperative percutaneous CT-guided localization using VATS markers was performed for 39 GGOs in 30 patients (77%). No serious

Comment

Recently, cases of small LBAC presenting with GGO have increased in Japan, due to the introduction of helical CT in screening for lung cancer. The present paper discusses the efficacy of limited surgical resection of LBAC, presenting as pure GGO on HRCT 1, 2, 3, 4, 5, 6, 19. Regarding surgical treatment of peripheral lung cancer, small tumor size alone does not represent a sufficient indication for limited surgery. Even small-sized tumors have the potential for mediastinal lymph node

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